Catheter pump with positioning brace

ABSTRACT

A catheter pump assembly is provided that includes an elongate body assembly, a shaft, and an impeller. The assembly has a proximal end, a distal end and at least one lumen extending therebetween. The shaft is disposed at least partially within the elongate body, e.g., in the at least one lumen, and journaled for rotation. The impeller is coupled with a distal portion of the shaft. The impeller is configured to be rotated to induce flow of blood when the impeller is placed in fluid communication with a source of blood. An inflatable balloon brace is disposed on an outer surface of the catheter pump. The inflatable balloon brace is spaced proximally of the impeller and has a low profile configuration for delivery through the vasculature and an expanded configuration for disposing (e.g., position and/or orienting) the impeller within the source of blood.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent ApplicationNo. 62/148,420, filed Apr. 16, 2015, the entire contents of which areincorporated by reference herein in their entirety and for all purposes.

BACKGROUND OF THE INVENTION

Field of the Invention

This application is directed to a catheter pump for mechanicalcirculatory support of a heart, and related components, systems andmethods. In particular, this application is directed to structures andmethods for positioning, e.g., by bracing, portions of such pumps in thevasculature and heart chambers.

Description of the Related Art

Heart disease is a major health problem that has high mortality rate.Physicians increasingly use mechanical circulatory support systems fortreating heart failure. The treatment of acute heart failure requires adevice that can provide support to the patient quickly. Physiciansdesire treatment options that can be deployed quickly andminimally-invasively.

Intra-aortic balloon pumps (IABP) are currently the most common type ofcirculatory support devices for treating acute heart failure. IABPs arecommonly used to treat heart failure, such as to stabilize a patientafter cardiogenic shock, during treatment of acute myocardial infarction(MI) or decompensated heart failure, or to support a patient during highrisk percutaneous coronary intervention (PCI). Circulatory supportsystems may be used alone or with pharmacological treatment.

In a conventional approach, an IABP is positioned in the aorta andactuated in a counterpulsation fashion to provide partial support to thecirculatory system. More recently minimally-invasive rotary blood pumphave been developed in an attempt to increase the level of potentialsupport (i.e., higher flow). A rotary blood pump is typically insertedinto the body and connected to the cardiovascular system, for example,to the left ventricle and the ascending aorta to assist the pumpingfunction of the heart. Other known applications pumping venous bloodfrom the right ventricle to the pulmonary artery for support of theright side of the heart. An aim of acute circulatory support devices isto reduce the load on the heart muscle for a period of time, tostabilize the patient prior to heart transplant or for continuingsupport.

There is a need for improved mechanical circulatory support devices fortreating acute heart failure. Fixed cross-section ventricular assistdevices designed to provide near full heart flow rate are either toolarge to be advanced percutaneously (e.g., through the femoral arterywithout a cutdown) or provide insufficient flow.

Expandable percutaneous pumps have also been developed. An importantvariable in expandable percutaneous pumps is the gap between the tip ofone or more blades of a rotatable impeller and a cannula wall withinwhich the impeller operates. Variation in the tip gap affects pumpingperformance and pump durability.

There is a need for a pump with improved performance and clinicaloutcomes. There is a need for a pump that can provide elevated flowrates with reduced risk of hemolysis and thrombosis. There is a need fora pump that can be inserted minimally-invasively and provide sufficientflow rates for various indications while reducing the risk of majoradverse events. In one aspect, there is a need for a heart pump that canbe placed minimally-invasively, for example, through a 15 FR or 12 FRincision. In one aspect, there is a need for a heart pump that canprovide an average flow rate of 4 Lpm or more during operation, forexample, at 62 mmHg of head pressure. While the flow rate of a rotarypump can be increased by rotating the impeller faster, higher rotationalspeeds are known to increase the risk of hemolysis, which can lead toadverse outcomes and in some cases death. Accordingly, in one aspect,there is a need for a pump that can provide sufficient flow atsignificantly reduced rotational speeds. These and other problems areovercome by the inventions described herein.

Further, there is a need for a motor configured to drive an operativedevice, e.g., a impeller, at a distal portion of the pump. It can beimportant for the motor to be configured to allow for percutaneousinsertion of the pump's operative device.

SUMMARY

A problem associated with the positioning of prior art catheter pumpshas been realized. Catheter pumps are disposed in a dynamic anatomicalarea in their normal use. That is, the pumping action of the heartincludes movement of valve leaflets, heart walls, and blood vesselscoupled with the heart. These movements and also the pressure wavesassociated with expulsion of blood from the left ventricle into theaorta are felt by the distal portion of the pump when it is positionedin the left ventricle. Percutaneously delivered catheter pumps aregenerally flexible to track through the arterial vasculature from aperipheral site. This flexibility makes the catheter pump more likely tobe affected by these movement and pressure waves. It is important fordirect unloading of the heart to keep the distal portion of the pump,which includes the blood intake, in the left ventricle. Shifting theintake out of the left ventricle (e.g. as a result of axial translationor dislocation) may result in pumping blood from the aorta which wouldhave less benefit to the heart and could even deprive the coronaryarteries of flow.

Also, more advanced, higher performance blood pumps have expandableimpellers that may be housed in expandable blood flow conduits. Suchdevices rely on predictable stable gaps between the impeller tip and theinner wall of the blood flow conduit during operation. Prior art devicesdo not address these problems. There is a need therefore for techniquesand/or structures to better enable high performance catheter pumps tomaintain a proper position and to operate with high efficiency whendisposed in the moving anatomy and subject to pressure fluctuations forextended periods of therapy.

In one embodiment, a catheter pump assembly is provided that includes anelongate body assembly, a shaft, and an impeller. The assembly has aproximal end, a distal end and at least one lumen extendingtherebetween. The shaft is disposed at least partially within theelongate body, e.g., in the at least one lumen, and is journaled forrotation. The impeller is coupled with a distal portion of the shaft.The impeller is configured to be rotated to induce flow of blood whenthe impeller is placed in fluid communication with a source of blood. Ananchor can be disposed along an outer surface of the catheter pump at anintermediate location and configured to be deployed therefrom to engagea vascular segment to hold in place a portion of the catheter pumpdisposed in the patient. In some embodiments, the anchor can comprise aninflatable balloon brace disposed on an outer surface of the catheterpump. The inflatable balloon brace can be spaced proximally of theimpeller and can have a low profile configuration for delivery throughthe vasculature and an expanded configuration for disposing (e.g.,position and/or orienting) the impeller within the source of blood.

More generally, a device or structure is provided to retain the positionof one or more parts of the catheter pump. The device or structure canbe a brace that can be expandable, e.g., a stent-like frame that can bedeployed from the catheter body. In some embodiments, the brace devicecan be one or a plurality of arms or struts that can be deployed from aside surface of a catheter body. Other brace devices can include coilsor fins that can extend away from the catheter body to engage thevasculature.

In certain applications it is preferred to not disrupt or minimallyaffect the blood flow to locations downstream of the balloon brace. Forthis reason, in various embodiments one or more channels is providedaround or through the balloon brace. The balloon brace can comprise atorus with an inflation member extending from the torus to the elongatebody assembly. In one embodiment, the balloon brace comprises a spokewheel that is expandable. The expansion of the wheel can be through aninflation lumen disposed in one or more of the spokes.

As an alternative to a balloon, the catheter body is placed in contactwith the aorta as discussed above and a proximal portion of the catheterpump is affixed to another part of the patient. The proximal portion canbe a portion of the catheter pump disposed outside the patient, e.g., ator adjacent to the percutaneous access site. The percutaneous accesssite is a femoral artery in one embodiment. The proximal fixation canthus be disposed at the leg, for example.

In one embodiment, a method is provided for positioning a catheter pumpin a patient. In the method, a catheter pump is inserted into aperipheral vascular location. The catheter pump has an elongate body anda flow generating device disposed at a distal portion of the elongatebody. The catheter pump has a brace disposed proximally of the flowgenerating device. The distal portion of the elongate body is advancedto a source of blood. The brace is deployed to reduce or minimizemovement of at least a distal portion of the elongate body. The bracecan include an extracorporeal securement device. The brace can includean expandable balloon brace.

In one method, the balloon brace is expanded from a side surface of theelongate body into contact with the vasculature. The contact preferablyis close to the heart. In one embodiment, the contact with thevasculature is at a location from which a distal portion catheter pumpcan extend along a substantially straight path to the left ventricle.For example, the balloon brace can be deployed anywhere between thecoronary arteries and the brachiocephalic artery. Placement at alocation closer to the brachiocephalic artery than to the coronaryarteries is advantageous in minimizing the chance of blocking thecoronary arteries.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of this applicationand the various advantages thereof can be realized by reference to thefollowing detailed description, in which reference is made to theaccompanying drawings in which:

FIG. 1 illustrates one embodiment of a heart pump configured forpercutaneous application and operation;

FIG. 1A is a plan view of one embodiment of a catheter assembly adaptedto be used with the heart pump of FIG. 1;

FIG. 2 is a detail view of a distal portion of the catheter assemblyillustrated in FIG. 1A;

FIG. 3 is an exploded view of a portion of an impeller assembly of thecatheter assembly of FIG. 1A;

FIG. 4A is a cross-sectional view of a distal portion of the catheterassembly, taken through the section plane 4A-4A shown in FIG. 2;

FIG. 4B is a detail view of the distal portion of the catheter assembly,taken at 4B-4B shown in FIG. 4A;

FIG. 5 is a cross-sectional perspective view of a bearing assembly ofthe catheter assembly of FIG. 1A;

FIG. 6 is a cross-sectional view of a bearing housing of the bearingassembly of FIG. 5;

FIG. 7 is a perspective view of one embodiment of a catheter body thatcan be used to house a drive shaft and to convey an infusate to thebearing housing of FIG. 5;

FIGS. 7A-7C show variations of the catheter body of FIG. 7;

FIG. 8 illustrates a surface configuration of one embodiment of abearing adapted to enhance or control flow of an infusate in the bearingassembly of FIG. 5;

FIG. 9 illustrates one embodiment of an impeller assembly;

FIGS. 9A, 9B-1, 9B-2, 10 and 10A illustrate details of furtherembodiments of impeller blades;

FIG. 11 is a cross-sectional view of a proximal portion of the catheterassembly, taken through the section plane 11-11 on FIG. 1A;

FIGS. 12, 12A, and 12B are cross-section views similar to that of FIG.11, illustrating an infusate outflow path;

FIG. 13 illustrates a prior art technique for placing a prior artcatheter pump;

FIG. 14 is a plan view of one embodiment of a catheter assembly adaptedto be used with the heart pump of FIG. 1;

FIG. 14A is an enlarged view of a portion of the catheter assembly ofFIG. 14 showing one embodiment of a balloon brace;

FIG. 14B is an enlarged view of a portion of another embodiment of thecatheter assembly of FIG. 14 showing a mechanically deployable brace;

FIGS. 15A-15C are sequential views of insertion of the heart pumpthrough the vasculature to a desired target position;

FIG. 16 shows another position for potential placement of a balloonbrace;

FIGS. 17A-D are perspective views of variations of a sheath assemblyhaving an expandable distal portion;

More detailed descriptions of various embodiments of components forheart pumps useful to treat patients experiencing cardiac stress,including acute heart failure, are set forth below.

DETAILED DESCRIPTION

Major components of heart pumps that can be applied percutaneously to apatient are described below in Section I. Section II describes variousstructures that facilitate the rotatable support of a cantileveredimpeller. Section III describes various structures that facilitatedeployment and/or retrieval of one or more components of the distal end108 of the heart pump 10 within the cardiovascular system. Section IVdescribes various methods and techniques in connection with specificstructures of heart pumps

I. Overview of Heart Pumps

FIG. 1 illustrates one embodiment of a heart pump 10 that includes acatheter assembly 100 having a proximal end 104 adapted to connect to amotor 14 and a distal end 108 (see FIG. 1A) adapted to be insertedpercutaneously into a patient. The motor 14 is connected by a signalline 18 to a control module 22 that provides power and/or controlsignals to the motor 14. As discussed further below, the heart pump 10in various embodiments has an infusion or operating fluid system 26 anda patient monitoring system 30.

The infusion system 26 can provide a number of benefits to the heartpump 10 which are discussed below. In one embodiment, the infusionsystem 26 includes a source of infusate or operating fluid 34, a fluidconduit 38 extending from the infusate source 34 to the proximal end 104of the catheter assembly 100 and a fluid conduit 42 extending from theproximal end of the catheter assembly 100 to a waste container 46. Theflow of infusate to and from the catheter assembly 100 can be by anymeans, including a gravity system or one or more pumps. In theillustrated embodiment, the infusate source 34 includes an elevatedcontainer 50, which may be saline or another infusate as discussedbelow. Flow from the elevated container 50 can be regulated by apressure cuff 54 to elevate the pressure of the fluid in the container50 to increase flow or by a pinch valve 58 or by other means.

The patient monitoring system 30 can be used to monitor the patientand/or operation of the pump 10. For example, the patient monitoringsystem 30 can include a user interface 60 coupled with a source of data64. The data source 64 can include one or more patient conditionssensors, such as pressure sensors 68 in pressure communication with thepatient, and/or operating components within the patient. In oneembodiment, the pressure sensors 68 fluidly communicate by a conduit 72that extends between the sensors and a proximal portion of the catheterassembly 100. The conduit 72 can include a plurality of separablesegments and can include a valve 76 to enable or disable the pressurecommunication to the sensors 68.

The heart pump 10 is adapted to provide an acute or other short-termtreatment. A short-term treatment can be for less than a day or up toseveral days or weeks in some cases. With certain configurations thepump 10 can be used for a month or more.

The catheter assembly 100 extends between the proximal end 104 and thedistal end 108. An impeller assembly 116 disposed at the distal end 108is configured to pump blood to convey blood from one body cavity toanother. In one arrangement, the impeller assembly 116 conveys bloodproximally through or along a portion of the catheter assembly 100 toprovide assistance to the left ventricle of the heart. In anotherembodiment, the impeller assembly 116 conveys blood distally through oralong a portion of the catheter assembly 100 to provide assistance tothe right ventricle of the heart. The heart pump 10 is useful as a heartassist device for treating patients with acute heart failure or otherheart maladies. The heart pump 10 also can be used in connection with asurgical treatment to support the patient without providing fullcardiovascular bypass. A patient could be supported on the device forlonger term with proper controls and design.

The catheter assembly 100 is provided with a low profile configurationfor percutaneous insertion. For example, the distal end 108 of thecatheter assembly 100 can be configured to have about an 11 French(approximately 3.5 mm) size in a first configuration for insertion andan expanded configuration, such as up to about 21 French (approximately7 mm), once positioned in the body. The larger size facilitates greaterflow rates by the impeller assembly 116 as discussed below.

The catheter assembly 100 is configured to enable the distal end 108 toreach a heart chamber after being inserted initially into a peripheralvessel. For example, the catheter assembly 100 can have a suitablelength to reach the left ventricle and sufficient pushability andtorquability to traverse the intervening vasculature. The catheterassembly 100 may include a multilumen catheter body 120 that is arrangedto facilitate delivery and operation of the impeller assembly 116.Variations of the catheter body 120 also can include inflation lumensfor deploying a brace as discussed below in Section III(A). Furtherdetails concerning various embodiments of the catheter body 120 arediscussed below in connection with FIGS. 7-7C.

A drive system is provided to drive an impeller within the impellerassembly 116. The drive system includes a motor 14 and a suitablyconfigured drive controller disposed within the control module 22. Themotor 14 in various embodiments is configured to be disposed outside thepatient, e.g., adjacent to the proximal end 104 of the catheter assembly100. In one advantageous embodiment, the drive system employs a magneticdrive arrangement. The motor 14 is arranged to generate magnetic fieldsthat will be sensed by permanent magnets disposed within the proximalend 104 of the catheter assembly 100. This arrangement facilitates veryefficient generation of torque used to drive the impeller assembly 116,as discussed below.

Some embodiments described herein could be incorporated into a system inwhich a motor is miniaturized sufficiently to be inserted into thepatient in use, including into the vasculature. Such an embodiment couldbe operated by disposing control signal lines within the proximalportion of the catheter body 120. Also, it may be useful to provide thecapability to measure blood pressure at the distal end 108 using adevice disposed at the proximal end 104. For example, a pressure sensorat the distal end can communicate with a device outside the patientthrough a lumen of the catheter body 120. Various details of theseoptional features are described in U.S. Pat. No. 7,070,555, which isincorporated by reference herein for all purposes and in its entirety.

In another embodiment, a mechanical interface can be provided betweenthe motor and the proximal end 104 of the catheter assembly 100. Themechanical interface can be between the motor 14 and a drive shaftpositioned at the proximal end of the catheter assembly 100.

A torque coupling system is provided for transferring torque generatedby the drive system to the impeller assembly 116. The torque couplingsystem is discussed further in Section II(C)—Torque Coupling System (asdiscussed below), but in general can include magnetic interface betweenthe motor 14 and a driven assembly 146 disposed at the proximal end 104of the catheter assembly 100. The driven assembly 146 is coupled with aproximal end of an elongate drive shaft 148 in one embodiment. The driveshaft 148 extends between the driven assembly 146 and the impellerassembly 116. A distal portion of the drive shaft 148 is coupled withthe impeller assembly 116 as discussed below in connection with oneembodiment illustrated in FIGS. 4A and 4B. FIG. 11 shows one manner ofcoupling the proximal end of the drive shaft 148 with the drivenassembly 146.

As discussed above, the heart pump 10 may also include an infusionsystem 26. FIG. 1A shows that the infusion system 26 can include aninfusion inflow assembly 150 provided adjacent to the proximal end 104in one embodiment. The infusion assembly 150 can be one component of aninfusion system that is configured to convey one or more fluids withinthe catheter assembly 100. The fluids can be conveyed distally withinthe catheter assembly 100, e.g., within the catheter body 120, tofacilitate operation of the impeller assembly 116, some aspect of atreatment, or both. In one embodiment, the infusion system is configuredto convey a lubricant, which can be saline, glucose, lactated Ringer'ssolution, acetated Ringer's solution, Hartmann's solution (e.g.,including compound sodium lactate), and D5W dextrose solution. Inanother embodiment, the infusion system is configured to convey amedication, or a substance that both acts as lubricant and medication.As sometimes used herein “infusate” is intended to be a broad term thatincludes any fluid or other matter that provides performance enhancementof a component of the heart pump 10 or therapeutic benefit, and can bewholly or partly extracted from the system during or after operation ofthe pump. The infusate is one example of an operating fluid.

In one embodiment, the infusion inflow assembly 150 includes a catheterbody 154 having a luer or other suitable connector 158 disposed at aproximal end thereof and an inflow port in fluid communication with oneor more lumens within the catheter assembly 100. A lumen extendingthrough the catheter body 154 is adapted to be fluidly coupled with afluid source connected to the connector 158 to deliver the fluid intothe catheter assembly 100 and through one or more flow paths asdiscussed below in connection with FIGS. 4A, 4B, and 7-7C.

FIGS. 1A and 12 show that the catheter assembly 100 in variousembodiments also includes an outlet positioned at a location that isoutside the patient when the heart pump 10 is in use to allow infusateto be removed from the pump and from the patient during or after thetreatment. The outlet can be fluidly coupled with an infusate returnflow path in the catheter body 120 through a fluid port 144 disposed atthe proximal end 104.

The catheter assembly 100 can also include a sheath assembly 162configured to constrain the impeller assembly 116 in a low profileconfiguration in a first state and to permit the impeller assembly 116to expand to the enlarged configuration in a second state. The sheathassembly 162 has a proximal end 166, a distal end 170, and an elongatebody 174 extending therebetween. In one embodiment, the elongate body174 has a lumen extending between the proximal and distal ends 166, 170,the lumen being configured to be slidably disposed over the catheterbody 120. The arrangement permits the sheath assembly 162 to be actuatedbetween an advanced position and a retracted position. The retractedposition is one example of a second state enabling the impeller assembly116 to expand to an enlarged configuration. As discussed further belowin Section III(A), a retracted position also can expose a brace orsupport device to be actuated during placement of a portion of acatheter pump assembly. The advanced position is one example of a firststate that enables the impeller assembly 116 to be collapsed to the lowprofile configuration. In some embodiments, a luer 102 or other suitableconnector is in fluid communication with the proximal end 166 of thesheath assembly 162. The luer 102 can be configured to deliver fluids tothe catheter assembly 100, such as priming fluid, infusate, or any othersuitable fluid.

FIG. 1A illustrates a retracted position, in which the distal end 170 ofthe elongate body 174 is at a position proximal of the impeller assembly116. In an advanced position, the distal end 170 of the elongate body174 is positioned distal of at least a portion of the impeller assembly116. The sheath assembly 162 can be configured such that distaladvancement of the distal end 170 over the impeller assembly 116actuates the impeller assembly 116 from an enlarged state to a morecompact state (or low profile configuration), e.g., causing a changefrom the second state to the first state, as discussed above.

FIGS. 4A & 4B show the elongate body 174 as a single layer structurefrom the inner surface to the outer surface thereof. In anotherembodiment, the elongate body 174 has a multilayer construction. In onearrangement, the elongate body 174 has a first layer that is exposed tothe catheter body 120 and a second layer exposed that corresponds to anouter surface of the catheter assembly 100. A third layer can bedisposed between the first and second layers to reinforce the elongatebody 174, particularly adjacent to the distal end thereof to facilitatecollapse of the impeller assembly 116. In another construction, areinforcing structure can be embedded in an otherwise continuous tubularstructure forming the elongate body 174. For example, in someembodiments, the elongate body 174 can be reinforced with a metalliccoil.

FIG. 2 show that an impeller housing 202 is disposed at the distal end108. The impeller housing 202 can be considered part of the impellerassembly 116 in that it houses an impeller and provides clearancebetween the impeller and the anatomy to prevent any harmful interactionstherebetween. The housing 202 and the impeller are also carefullyintegrated to maintain an appropriate flow regime, e.g., from distal toproximal or from proximal to distal within the housing.

FIGS. 1A and 2 also show that the distal end 108 of the catheterassembly 100 includes an atraumatic tip 182 disposed distal of theimpeller assembly 116 in one embodiment. FIG. 1A shows that theatraumatic tip 182 can have an arcuate configuration such thatinteractions with the vasculature are minimally traumatic. The tip 182can also be configured as a positioning member. In particular, the tip182 can be rigid enough to help in positioning the impeller assembly 116relative to the anatomy. In one embodiment, the tip 182 is rigid enoughthat when it is urged against a heart structure such as the ventriclewall, a tactile feedback is provided to the clinician indicating thatthe impeller assembly 182 is properly positioned against the heartstructure.

II. Impeller Rotation and Support

The impeller assembly 116 can take any suitable form, but in variousembodiments includes an impeller 200 adapted to move a fluid such asblood from an inlet to an outlet of the catheter assembly 100. Incertain embodiments the impeller 200 can be cantilevered or otherwisesupported for rotation primarily at one end.

FIG. 3 shows that the impeller 200 includes a shaft 204, a central bodyor hub 208, and one or more blades 212.

The shaft 204 and hub 208 can be joined in any suitable fashion, such asby embedding a distal portion of the shaft within the hub 208. Theblades 212 can be spaced out proximal to distal along the axis of theshaft. In some embodiments, the blades 212 are provided in blade rows.FIG. 9 shows that the distal end of the shaft 204 can extend at least toan axial position corresponding to one of the blade rows. In someembodiments, the shaft 204 can be solid. In other embodiments, the shaft204 has a lumen extending axially through the hub so that a guidewirecan be passed through the catheter assembly 100. Details of variationswith a lumen are discussed further in U.S. Application Publication No.2011/0004046A1, Published Jan. 6, 2011, titled Blood Pump WithExpandable Cannula, which is hereby incorporated by reference herein inits entirety and for all purposes. Additional details of the impellermay be found throughout U.S. Pat. No. 8,721,517, issued May 13, 2014,which is incorporated by reference herein in its entirety and for allpurposes.

A. Operating Fluid Delivery and Removal System

The operation and duty cycle of the impeller assembly 116 can belengthened by providing a hydrodynamic bearing for supporting the shaft204. A hydrodynamic bearing can be supported by an operating fluid suchas isotonic saline or other lubricant, which can be delivered in acontinuous flow. The lubricant can be delivered through the infusionsystem to an outside surface of the shaft 204. The infusate may bedirected onto the shaft from a radially outward location. In somearrangements, the lubricant flow is controlled such that of a totallubricant volume introduced into the proximal end of the cannula, afirst portion of the total volume of the lubricant flows proximallyalong the shaft 204. In some embodiments, a second portion of the totalvolume flows distally along the shaft, the first volume being differentfrom the second volume. The second portion of the total volume can besubstantially equal to the total volume introduced into the proximal endof the cannula less the first volume.

FIGS. 3 to 8 show various structures for providing rotational support ofa proximal portion of the shaft 204 within the distal portion of thecatheter assembly 100. For example, as shown in FIG. 3, a bearingassembly 220 can be disposed at a distal end 224 of the multilumencatheter body 120. In one embodiment, the bearing assembly 224 includesa housing 228 (as shown in FIG. 4B) and one or more bearings configuredto support the proximal portion of the shaft 204. The bearing assembly224, as illustrated in more detail in FIG. 4B, includes a plurality ofbearings 232 a, 232 b disposed within the bearing housing 228. Variousmaterials that can be used for the bearings are discussed below.

FIG. 6 shows that the bearing housing 228 has a lumen 234 extendingtherethrough with a proximal enlarged portion 236 a and a distalenlarged portion 236 b. The housing 228 comprises a shoulder defining anarrow portion 240 of the lumen 234 disposed between the enlargedportions 236 a, 236 b. The first and second bearings 232 a, 232 b can bedisposed within the enlarged portions 236 a, 236 b of the bearinghousing 228.

In one arrangement, the proximal end of the shaft 204 (e.g., as shown inFIG. 4A) is received in and extends proximally of the second bearing 232b. In some embodiments there can be one bearing (e.g., only bearing 232a), while in other embodiments both bearings 232 a and 232 b can beused. In some embodiments, the bearing(s), e.g., bearings 232 a and/or232 b, can be friction fit or interference fit onto the impeller shaft204. Accordingly, the shaft 204 can be supported for rotation by thebearings 232 a, 232 b as well as in the narrow portion 240 of thehousing 228. In embodiments where the bearing(s) 232 a, 232 b arefriction or interference fit onto the shaft, the bearing(s) 232 a, 232 bcan be configured to rotate with the shaft 204 relative to the bearinghousing 228. Further, the bearing(s) 232 a, 232 b can have a relativelylarge clearance with the bearing housing 228. The clearance between theshaft 204 and the bearing housing 228, at regions that are not coupledwith the bearing, can be in the range of about 0.0005 to about 0.001inch. In certain embodiments, the clearance can be within a largerrange, such as at least about 0.0005 inches, about 0.001 inches or up toabout 0.005 inches. In embodiments with multiple bearing(s) 232 a, 232b, the clearance can be different for the bearings 232 a, 232 b, such asproviding a larger clearance at the proximal bearing 232 a.

In other embodiments, such as in FIG. 5, the bearing(s) 232 a, 232 b maynot be friction or interference fit onto the shaft 204. In theseembodiments, the bearing(s) 232 a, 232 b may be disposed within thebearing housing 228, for example by an interference or press fit. Theshaft 204 may then rotate with respect to the bearing(s) 232 a, 232 b,and there can be a clearance between the shaft 204 and the bearing(s)232 a, 232 b. The clearance between the shaft 204 and the bearings 232a, 232 b can be in the range of about 0.0005 to about 0.001 inch. Incertain embodiments, the clearance can be within a larger range, such asat least about 0.0005 inches, about 0.001 inches or up to about 0.005inches. The clearance can be different for the bearings 232 a, 232 b,such as providing a larger clearance at the proximal bearing 232 a. Incertain embodiments, the bearing housing 228 may provide a thrustsurface for bearing axial loads. In other embodiments, there may beother bearings located either distally or proximally of the bearinghousing 228 that are configured to bear axial loads. In otherembodiments, the fit between the bearings 232 a, 232 b and the shaft 204can be tight, which can also assist in bearing axial loads in someaspects.

At least the proximal portion of the shaft 204 can be made of a materialthat will not corrode or otherwise be made to be inert when immersed inthe lubricant or other infusate. The material may be one that will notcorrode in isotonic saline. Suitable materials may include a widevariety of metals, including alloys, and at least saline-resistantstainless steel and nickel-based alloys. Also, the shaft 204 could bemade as a composite to include advantageous properties of a plurality ofmaterials. In some cases the shaft 204 could be formed as a polymer. Theclass of polymers selected would include those that can form a shaft 204of a certain stiffness suitable in this application. For example,polycarbonate or PEEK could be used. In certain configurations, thepolycarbonate, PEEK, or other suitable polymer can provide enhancedperformance by being combined with a second material or structure. Aglass or carbon filled polycarbonate or other stiff polymer could alsobe used.

As discussed above, a hydrodynamic bearing between the shaft 204 and thebearings 232 a, 232 b may be utilized in various embodiments. In onesuch arrangement, a continuously replenished fluid film is provided atleast between the inner wall of the bearing housing and an adjacentmoving structure, such as the impeller shaft or an outer surface of abearing. For example, the bearing housing 228 can be configured topermit a lubricant to be delivered therethrough into the lumen 234. Thebearing housing 232 can include a plurality of channels 260 disposedtherein extending proximally from a plurality of ports 264 located atthe narrow portion 240 of the housing 228. Each port 264 can communicatewith one of the channels 260 to provide fluid communication into thelumen 234.

As shown in FIG. 5, the channels 260 can be formed in the wall of thehousing 228. In one embodiment, the channels 260 are formed as opendepressions, e.g., as flutes, extending along the housing 228. In thisembodiment, the channels 260 can be enclosed by a separate structure,such as a separate outer sleeve, that is disposed around the housing228. FIG. 4B shows that a proximal portion 268 of the impeller housing202 can be sized to tightly fit over the outer surface of the bearinghousing 228, enclosing the radially outward portion of the channels 260.In this arrangement, at least a portion of a flow path is formed betweenan outer surface of the bearing housing 232 and a separate outer sleeve.

Fluid communication between the port 264 in the bearing housing 228 andthe infusion inflow assembly 150 can be by any suitable combination oflumens within the catheter assembly 100. For example, in one embodiment,each of the channels 260 has a proximal port 272 that communicationswith an annular space 274 formed in the catheter assembly 100. Theannular space 274 can be formed between a plurality of separate overlaidstructures in the catheter assembly 100. FIGS. 4A and 4B show that theannular space 274 is formed between an outer surface 278 of themultilumen catheter body 120 and an inner surface of the proximal length268 of the housing 202.

Fluid communication is provided in the catheter assembly 100 between thespace 274 and the infusion inflow assembly 150. For example, a pluralityof lumens 282 formed in the multi-lumen catheter body 120 can bedispersed circumferentially about the catheter body 120 at a peripheralcircumferential region 284, as illustrated in FIGS. 7-7C. The peripheralposition of the lumens 282 enables a central area of the catheter body120 to be dedicated to a central lumen 286. By providing a plurality ofsmaller lumens 282 located at the periphery, a relatively large flowrate can be delivered through a relatively small circumferential band(when considered in cross-section) of the catheter body 120. In someembodiments, each of the lumens 282 has a distal port 290 thatcommunicates with the space 274. In some embodiments, one or more of thelumens 282 can be in fluid communication with an inflatable balloonbrace as discussed further below in connection with FIGS. 15-16C.

A proximal portion of the lumens 282 can take any suitable form. Forexample, the lumens 282 can communicate at their proximal end with aflow diverting structure (not shown) that is in fluid communication withthe infusion inflow assembly 150. As described herein, in someembodiments the lumen 282 can be disposed circumferentially about thecentral lumen 286. The catheter assembly 100 can include a flowdiverting structure or connector, e.g., disposed about the proximal endof the catheter body 120 that is configured to divert the infusate intothe lumens 282 for distally directed flow therein. In other embodiments,the catheter assembly 120 can include a flow diverting structuredisposed adjacent the distal end thereof that is configured to divertthe infusate into the lumens 282 from the central lumen 286 forproximally directed flow in the lumens 282.

FIG. 5 includes arrows that illustrate the flow of infusate into thebearing assembly 220. In one arrangement, the inflow of infusate isindicated by an arrow 300 which is shown pointing distally within one ofthe channels 260 of the bearing housing 228. The infusate flow entersthe bearing housing through the ports 264. Although flow is shown in onechannel 260, corresponding flow may be provided in each of a pluralityof channels 260 disposed around the central lumen 234. An arrow 304illustrates that at least a portion of the infusate delivered throughthe port 264 may flow generally proximally within the bearing housing228. An arrow 308 illustrates that at least a portion of the infusatedelivered through the port 264 may flow generally distally within thebearing housing 228.

FIG. 5 illustrates the arrows 304, 308 as proximally and distallydirected, respectively. However, the high speed rotation of the impellershaft 204 within the housing 228 will create a thin film of lubricantspacing the impeller shaft 204 from the surfaces of the bearings 232 a,232 b. This thin film will extend all the way around the shaft 204 andthus each portion of the flow will have a spiral or helical flowdirection.

The bearings 232 a, 232 b can have different configurations to enhancethe performance of the pump 10. For example, the proximal bearing 232 acan be longer along the longitudinal axis of the bearing housing 228than the distal bearing 232 b. A longer proximal bearing 232 a isbelieved to better control runout of the shaft 204. Better runoutcontrol on the shaft 204 is believed to enhance the control of theposition of the blades 212 relative to the housing 202. Less runoutreduces excessive variation in the gap between the blades 212 and thehousing 202, providing biocompatibility benefits such as reducedhemolysis.

In some embodiments, such as those in FIG. 5 where the bearings 232 a,232 b are not friction fit or interference fit onto the shaft 204, thedistal bearing 232 b has a smaller inner diameter than the proximalbearing 232 a. If the shaft 204 has a constant diameter, the smallerinner diameter should provide greater control of angular deflection ofthe shaft. Controlling angular deflection can enhance relative positioncontrol of the blades 212 and housing 202, providing blood handlingbenefits such as reduced hemolysis. A smaller clearance could also beprovided by enlarging the diameter of the shaft 204 at the axialposition of the distal bearing. In some embodiments, the larger innerdiameter of the bearing 232 b enables a larger volume of lubricant toflow proximally and a lesser volume to flow distally in the lumen 234.

The continuous introduction of lubricant maintains a constant,predictable and durable rotational bearing state between stationarycomponent, e.g., the bearing housing 282, and a moving component, e.g.,the shaft 204, a component of the bearings 232 a, 232 b, or both theshaft 204 and a component of the bearings 232 a, 232 b. Also, continuouslubricant inflow provides a means for removing heat generated by therelative motion between the shaft 204 and the bearings. Also, theinfusate can create fluid pressure within the catheter assembly 100 thatcan push debris generated within or by the pump 10 out of the bearinghousing 220. Enhancing the volume of infusate that flows along the pathindicated by the arrow 304 enhances the likelihood that debris generatedby or present in the pump will be removed from the proximal end ratherthan to be trapped inside the distal portion of the catheter assembly100.

Another technique for controlling infusate flow in the lumen 234 is tolocate the port 264 between the bearings 232 a, 232 b and closer to oneof the bearing. For example, the ports 264 can be located adjacent tothe proximal bearing 232 a in one embodiment. This provides a shorterpath of egress out of the narrow portion 240 of the bearing housing 228in the proximal direction.

Other strategies for controlling the flow of infusate within the bearinghousing 228 include modifying a surface within one or more of thebearings 232 a, 232 b. FIG. 8 shows a surface modification 233 providedin a bearing 232 a to enhance proximally directed flow. The surfacemodification 233 comprises a plurality of axially oriented grooves 235in one embodiment. In another embodiment, the surface modification 233includes one or more spiral grooves. The spiral grooves can be formedwith a groove entrance that is substantially parallel with a flowdirection of infusate between the bearings 232 a, 232 b such that areduction of velocity of the flow is minimized. In one embodiment, eachspiral groove includes at least about 3 turns disposed on the innersurface of the bearing between the proximal and distal ends of thebearing. In another embodiment, each spiral groove has adjacent turnsthat are spaced apart by a minimum pitch of 0.125 inches (3.2 mm). Inanother embodiment, each spiral groove has an axial density of about 32turns per inch (about 1.3 turns per mm). The grooves are formed in thesurface 237 of the bearing 232 a upon which the impeller shaft 204 issupported. The grooves 235 locally enlarge the clearance between theshaft 204 and the surface 237 so that a greater volume of infusate canflow distal-to-proximal across the bearing 232 a. The surfacemodification 233 reduces back-pressure limiting the distal-to-proximalflow across the bearing 232 a.

In other embodiments, it may be desirable to enhance distally directedflow. For example, the infusate may be provided with a fluid intended tobe delivered to the patient. In such embodiments, the surfacemodification 233 can be provided on the distal bearing 232 b. In certainembodiments, both proximal and distal bearings 232 a, 232 b are providedwith flow enhancing modifications to enhance heat transfer or purging ofthe bearing assembly 220. In such embodiments, one of the bearings mayhave a greater degree of flow enhancement provided on the bearingsurface.

The arrangement of the bearing assembly 220 can be a factor in selectingan appropriate infusate. Saline is a preferred infusate, but othersufficiently biocompatible infusates could be used. Other embodimentsare configured such that little or no infusate flows out of the pumpinto the patient. For such embodiments, other infusate fluids can beused, such as glucose.

FIG. 7 illustrates further features of the catheter body 120. Thecatheter body 120 comprises an inner most portion 320 that defines thecentral lumen 286. The inner most portion 320 is disposed within, e.g.,circumferentially surrounded by, the peripheral circumferential region284. A continuous outer circumferential region 324 can be providedaround the peripheral circumferential region 284 to fully enclose thelumens 282, discussed above. FIGS. 4A and 4B illustrate that a distalend of the inner most portion 320 is configured to be received andsecured within a proximal portion of the lumen 234 within the bearinghousing 228. FIG. 4B illustrates that a region of overlap can beprovided between a distal portion of the inner most portion 320 and aproximal portion of the bearing housing 228. This construction providesa continuous lumen defined in part by the central lumen 286 of thecatheter body 120 and in part by the lumen 234 of the bearing housing.In another arrangement, the bearing housing 228 and the catheter body120 are joined by a coupler that enhances the sealing between infusateinflow through the lumens 282 and the channels 260 and the infusateoutflow through the central lumen 286. As discussed further below, thiscontinuous lumen provides a space for the rotation of the shaft 204 ofthe impeller assembly 116 and the drive shaft 148 of the torque couplingsystem.

The physical connection between the bearing housing 228 and the catheterbody 120 can be achieved in any suitable manner. FIG. 3 illustrates thatin one arrangement, a slideable connection is provided. In thisarrangement, a rod 332 is provided between the bearing housing 228 andthe catheter body 120. The rod 332 can have any suitable configuration,but may have a proximal end configured to be received in a recess orlumen formed in the catheter body 120 and a distal end 340 configured tocouple with the bearing housing 228. FIG. 3 shows that the distal end340 of the rod 332 can be configured to engage with a feature of thebearing housing 228 so that a limited range of sliding is permitted.

In one embodiment, the bearing housing 228 has an elongate channel 342configured to receive a middle portion of the rod 332 and an enlargeddepression 344 located at the distal end of the channel 342. Thedepression 344 has a width W that is sufficient to receive a wide distalend of the rod 332. The depression 344 can be configured to have anaxial length along the housing 228 that can define a range of motion ofthe bearing housing 228 relative to the catheter body 120.

In one arrangement, the bearing housing 228 is positioned relative tothe catheter body 120 and the rod 332 such that the distal portion ofthe rod 332 is located at the distal end of the depression 344.Thereafter, the catheter assembly 100 can be manipulated such that thebearing housing 228 moves distally relative to the catheter body 120 andthe rod 332 such that the distal portion of the rod 332 is located atthe proximal end of the depression 344. In the distal position, theimpeller assembly 116 is located more distally than in the proximalposition. As discussed further below, this enables a variety oftechniques for unfurling the impeller blades 212 within the housing 202.

B. Bearing Configurations

Any suitable bearing can be used in the catheter assembly 100. Theprovision of an infusate for hydrodynamic support enables a wide rangeof bearing materials to be used. If saline or other more corrosiveinfusate is used, the bearing must be carefully configured to notdegrade within the expected duty cycle of the pump 10. Some polymericmaterials are advantageously not degraded by isotonic saline, and areacceptable materials from this perspective. Under the fluid-dynamicconditions, a hydrodynamic bearing that is supported by a biocompatibleinfusate such as isotonic saline is preferred. It is believed thatcertain polymer bearings in combination with isotonic saline can supportsuch conditions as 35,000-50,000 psi-ft/min for an appropriate dutycycle. Other aspects that can guide the choice of bearing configurationsinclude minimizing thermal expansion, given the heat that could begenerated in the heart pump 10, and minimizing moisture absorption.

Any suitable polymeric material may be used for the bearings 232 a, 232b. The polymeric material can include a homopolymer, a copolymer, or amixture of polymers. The polymeric material can include thermoplastic orthermoset polymers. Examples of polymers that can be used for bearings232 a, 232 b include, but are not limited to, one or more of apolyketone, a polyether, a polyacetal, a polyamide-imide, a polyacetal,polyether ether ketone (PEEK), polytetrafluoroethylene (PTFE), andpolyphenylene sulfide (PPS).

The polymeric material can also include (e.g., can be mixed, combined,and/or filled with) one or more additives such as a reinforcer and alubricant. Specific additives include, but are not limited to, graphite,carbon fiber, glass fiber, and PTFE. Those of ordinary skill in the artmay appreciate that the additives may be polymeric or non-polymeric. Insome embodiments, the polymeric material used for bearings 232 a and/or232 b can include PEEK, carbon fiber, PTFE, and graphite. In otherembodiments, the polymeric material can include PPS and glass fiber. Inyet other embodiments, the polymeric material can include apolyamide-imide polymer, carbon fiber, and graphite. The polymericmaterial can include any suitable amount of additive(s). For example,the polymeric material can include a total amount of additive(s) in therange of from about 1 wt % to about 50 wt %, based on the total weightof the polymeric material. In other embodiments, the polymeric materialused for bearings 232 a, 232 b may not include any additives.

The polymeric material chosen for bearings 232 a, 232 b can haveparticular characteristics that advantageously affect the performance ofthe bearings. For example, in order to minimize thermal expansion causedby the heat generated in the heart pump 10, a preferred material wouldbe subject to a minimum of dimensional change, and can have acoefficient of thermal expansion in the range of from about 1.2×10⁻⁵°F.⁻¹ to about 25.2×10⁻⁵° F.⁻¹. In other embodiments, the polymer usedfor bearings 232 a, 232 b has a coefficient of friction in the range offrom about 0.15 to about 0.3. In another example, in order to minimizeor prevent water absorption, the selected polymeric material can have awater adsorption in the range of from about 0.01% to about 0.4% over a24 hour period. In yet another example, the polymeric material can besuitable for high pressure and velocity performance, and can have alimiting pressure-velocity (PV) in the range of from about 20,000psi-ft/min to about 50,000 psi-ft/min.

The polymeric material used for bearings 232 a, 232 b may becommercially available. Examples of suitable, commercially-availablepolymeric materials include, but are not limited to, Ketron PEEK-HPV,Turcite A, Turcite X, Turcite TX, Rulon LR, Rulon J, Rulon 641, RulonAR, Techtron HPV PPS, Ryton PPS, Torlon 4301, and Torlon 4501. In someembodiments, the polymeric material used for bearings 232 a, 232 b isKetron PEEK-HPV.

Of course, other bearing configurations and/or materials would besuitable under other conditions, e.g., with less corrosive infusates orif a hydrostatic or non-hydraulic bearing is used.

C. Torque Coupling Systems

A torque coupling system is provided to rotate the impeller 200 at ahigh rate to move blood from inside a heart camber to a location withina patient's vasculature in amounts sufficient to sustain the patient orprovide treatment to the patient. The torque coupling system couples theimpeller 200 with the motor 136, which may be disposed outside thepatient. It is expected that the impeller 200 and the drive shaft 148are to be rotated at 25,000-30,000 revolutions per minute for a periodof seven to ten days. To provide reliable performance under theseconditions, isotonic saline or other lubricant is provided between thedrive shaft 148 and stationary components therearound.

FIGS. 11 and 4B illustrate proximal and distal portions 400, 404 of thedrive shaft 148. The proximal portion is coupled with the drive assembly146 such that rotation of the drive assembly 146 rotates the drive shaft148. The distal portion 404 of drive shaft 148 is coupled with theimpeller shaft 204 such that rotation of the drive shaft 148 causesrotation of the impeller shaft 204. The drive shaft 148 also includes anelongate body 408 that extends between the proximal and distal portions400, 404. The elongate portion 408 comprises a lumen 412 extendingtherethrough.

The size of the elongate body 408 may be as small as possible tominimize the cross-sectional profile of the catheter assembly 100. Thecross-sectional profile of the catheter assembly 100 corresponds to thecrossing profile of the catheter assembly, which limits where the systemcan be inserted into the vasculature. The lumen 412 is sized to permit aguidewire to be advanced therethrough in some embodiments. The use of aguidewire is optional, but may simplify insertion.

In one embodiment, the elongate body 408 comprises a multi-layerconstruction. In some embodiments, each layer can include at least onecoil wire or a plurality of coil wires all wound in a same orientation.For example, a two-layer, counter-wound wire construction isparticularly advantageous. A first layer (e.g., an inner layer) of theelongate body 408 is provided by a coiled wire ofnickel-molybdenum-chromium alloy, such as 35NLT or MP35N. In otherembodiments, the wire material can be MP35N LT. In one embodiment, thewire has a 0.008 inch diameter and the coil has a 5 filar right-handwound construction. The outer diameter of the first layer may be about0.071 inch. A second layer (e.g., an outer layer) of the elongate body408 can include the same material as the first layer, disposed on theoutside of the first layer. The first and second layers can be wound inthe same direction, or in opposite directions. For example, in someembodiments the first layer (e.g., an inner layer) can be left-handwound and the second layer (e.g., an outer layer) can be right-handwound, or vice versa. In other embodiments, both the first and secondlayers can be left-hand wound. In yet other embodiments, both the firstand second layers can be right-hand wound. The wound coil wireconstruction can advantageously facilitate proximal and/or distal flowof infusate along the outer layer of the elongate body 408. For example,the outer layer can be constructed such that the infusate travels alongthe coil and/or in the direction of the winding. Those skilled in theart may appreciate that, depending on the direction of rotation of theelongate body 408, the infusate flow can advantageously be directedeither proximally or distally. The second layer may be a 5 filarleft-hand wound construction. In one embodiment, each layer is formedusing a 0.008 inch diameter wire, in the above-noted coiledconfiguration. In other embodiments, the elongate body 408 can includethree or more coil wire layers, wherein the layers are wound inalternating directions. In some embodiments, the outer diameter of thesecond layer can be between about 0.072 inch and about 0.074 inch, whilein other embodiments the diameter can be much larger or smaller. In someaspects, for example, the outer diameter of the second layer can beabout 0.073 inch. The inner diameter of the elongate body 408 can be atleast about 0.039 inch in some implementations. In some embodiments, oneor more ends of the elongate body 408 can be welded and square cut, forexample, with a 0.1 inch maximum weld length on each end. The length ofthe elongate body 408 can vary, but in some embodiments, the length canbe between about 47 inches and 48 inches, for example, about 47.5inches.

Other materials and other constructions are possible. The elongate body408 can be made of other non-ferrous metals or other corrosion resistantmaterial or constructions with appropriate modulus. Other materials thatcould meet the corrosion requirements include stainless steel (e.g.,302, 304, or 316). In certain embodiments, the elongate body 408 canhave a structure that enables other materials to be used. For examplevarying at least one of coil layers, filars, wire diameter, and coildiameter may enable an otherwise less robust material to operate belowthe fatigue stress of that material.

In another embodiment, a four layer construction is provided. The fourlayers comprise three wire-wound layers, e.g., similar to thearrangement described above, but included a third wound layer on theouter surface of the second layer. A low friction layer can be disposedon the outside surface of the elongate body 408. One material that couldbe used as a low-friction layer is PTFE, known commercially as Teflon®.The low-friction layer should be configured to have sufficient wearresistance, such as by selection of the appropriate PTFE material, e.g.polyphenylene sulphone-filled PTFE, and/or by insuring appropriateinfusate flow is maintained during the entire duration of use of thedevice in order to prevent undesirable local elevated temperature of thePTFE material.

The drive shaft 148 operates within the multilumen catheter body 120.Because the drive shaft 148 is rotated at a very high rate when in usewithin the multilumen catheter body 120, the configuration of thesurface forming the central lumen 286 is important. In some embodiments,this inner surface has high lubricity and high wear resistance. Onematerial that can be used for the inner surface of the catheter body 120is high density polyethylene (HDPE), which provides sufficient lubricityand wear resistance. In one embodiment, the entire multilumen catheterbody 120 is formed of HDPE. PTFE provides good lubricity and could beused if made sufficiently wear resistant. One way to increase the wearresistance of PTFE is to impregnate it with polyphenylene sulphone(PPSO₂), another is to gamma irradiate the material. One way to increasethe lubricity of Polyimide materials is to impregnate it with Graphite,another is to impregnate it with Graphite and PTFE.

FIG. 4B shows a clearance 412 between the elongate body 408 of the driveshaft 148 and the inner surface of the multilumen catheter body 120. Theclearance 412 may be about 0.005 inch. Along a diameter between oppositesides of the inner surface of the central lumen 286 and outer surface ofthe elongate body 408 includes about 0.010 inch of space or diametricclearance. A larger minimum clearance may be desirable if the crossingprofile can be enlarged or if other structures of the catheter assembly100 can be made thinner or eliminated to allow more room between theelongate body 408 and the central lumen 286.

FIGS. 11 and 12 show further details of the drive assembly 146, which isdisposed at the proximal end 104 of the catheter assembly 100. The driveassembly 146 includes a drive housing 450 having a recess or cavity 454disposed therein. The cavity 454 is configured for mounting a rotorsupport shaft 458 for rotation therein. The support shaft 458 has aproximal end and a distal end and a plurality of components mountedthereon. The distal end of the support shaft 458 has a recess 462 formedtherein to receive a proximal end of the drive shaft 148. The supportshaft 458 may also have a lumen 466 disposed therein for slideablyreceiving a guidewire.

A rotor 470 is mounted on an outer surface of the support shaft 458between sleeve bearings 474 a, 474 b, as shown in FIG. 12. The rotor 470can take any suitable form, but in one embodiment includes an elongatemagnet 476 disposed between proximal and distal flywheels 478 a, 478 b.

The proximal end of the support shaft 458 has a tapered port 480 forreceiving the guidewire. The proximal end can be configured for engagingthe motor 136 in some embodiments. In other embodiments, a magneticfield is induced by the motor 136 in a manner that creates torque androtation of the shaft 458.

An infusate outflow path 482 is provided within the drive assembly 146.The outflow path 482 is provided between an outer surface of the supportshaft 458 and an inner surface 486 of the distal bearing. The flow path482 continues from the distal bearing 474 b radially outwardly alongthrust surfaces 490 a. The flow path continues proximally between theouter surface of the rotor 470 and the inner surface defining the cavity454. The flow path 482 continues radially inwardly along the thrustsurface 490 a toward the support shaft 458. The flow path 482 continuesproximally between the support shaft 458 and the proximal bearing 474 a.Proximal of the bearing 474 a, the flow of infusate exits the catheterassembly 100 through an outflow port 144 through which it can bedirected to the waste container 46 or discarded. The flow path is shownin more detail in FIGS. 1, 12, 12A, and 12B.

III. Structures that Facilitate Deployment and Retrieval

The catheter assembly 100 can include one or more features thatfacilitate the deployment and/or retrieval of one or more components ofthe distal end 108 of the heart catheter assembly 100 (e.g., theimpeller assembly 116 or a portion thereof). The catheter assembly 100can be used in conjunction with any of the pumps, catheter assemblies,systems, or components thereof disclosed in U.S. Pat. Nos. 8,992,163;8,535,211; 9,138,518; 8,597,170; 8,485,961; 8,591,393, in U.S. PatentPublication Nos. 2013/0066140; 2013/0303970; 2014/0275725; 2013/0303969;2015/0099922; 2014/0012065; 2014/0010686; 2014/0275726; 2015/0290372;2015/0290371, in U.S. Application No. 61/979,876; 61/979,925;61/979,937; 62/038,678; Ser. Nos. 15/003,576; 15/003,682; 15/003,696, orin International Publication Nos. WO 2015/160942; WO 2015/160980; WO2015/160990; WO 2016/028644, the contents of each of which are herebyincorporated by reference herein in their entirety and for all purposes.

A. Catheter Assembly with Position and/or Orientation Holding Brace

FIG. 13 shows a prior art catheter system with a guide catheter 132 of apump system 130. As discussed above, the pump system 130 is underseveral distinct loads in operation. The heart is continually beatingand is physically contacting the pump system 130 at least at the aorticvalve 13 in every heartbeat. The fluid pressures in the left ventricle15 and in the aorta 13 differ and also vary over time. The systemtypically generates some axial loads in response to the pumping offluid. Though these axial loads are applied to the system in FIG. 13,there is no structure or method in the system 130 of FIG. 13 to maintainthe position of the pump under these conditions. FIGS. 14-15C illustrateintravascular structures and methods that stabilize the position of theworking end of a catheter pump and minimize or reduce tip gapvariability in a cannula of a percutaneous pump with an expandableimpeller.

FIG. 14 show a catheter assembly 500 that is similar to the catheterassembly 100 except as discussed below. The catheter assembly 500 can becombined with a controller and the various other components of acatheter pump disclosed herein. The catheter assembly 500 includes acatheter body 560, an elongate body 504 disposed about the catheter body560, a shaft 508, and an impeller assembly 116 comprising an impeller510 connected to the shaft 508 (see FIG. 15B). The impeller 510 operateswithin a cannula 518 that carries blood from a heart chamber (or othersource of blood) to a blood vessel such as the aorta or pulmonary arteryin a ventricular support context. The catheter assembly 500 has aproximal end 512, a distal end 516 and at least one lumen extendingtherebetween. The lumen is not shown but is similar to the lumen 286shown in FIG. 7. The shaft 508 (shown in FIG. 15B) is disposed at leastpartially within the elongate body 504, e.g., in at least one lumen ofthe catheter body 560. The shaft 508 is journaled for rotation in thelumen. The impeller 510 is coupled with a distal portion of the shaft508 (see FIG. 15B). The impeller 510 is configured to induce flow ofblood when the impeller 510 is rotated in fluid communication with asource of blood. For example, a proximal end of the shaft 508 can beconnected to a motor (such as the motor 14), which can rotate the shaft508 and, in turn, the impeller 510.

An exemplary anchor comprising an inflatable balloon brace 532, shownschematically in FIGS. 14-14A and 15B-16, is disposed on an outersurface of the catheter pump or the catheter assembly 500. Theinflatable balloon brace 532 is spaced proximally of the impeller 510.The inflatable balloon brace 532 has a low profile configuration fordelivery through the vasculature and an expanded configuration fordisposing (e.g., positioning and/or orienting) the impeller 510 withinthe heart or other source of blood. The exemplary anchor (e.g. balloonbrace) is configured to expand against the adjacent tissues walls suchas the inner walls of the aorta. For example, the balloon brace 532 maybe expanded in a manner similar to that used for balloon pumps and/orstents. In some arrangements, an inflation lumen can be provided in thecatheter assembly 500 which provides fluid communication between theinterior of the balloon brace 532 and an inflation system. The inflationsystem can supply a fluid (any suitable gas, such as helium, etc.) tothe balloon brace 532 by way of the inflation lumen to cause the balloonbrace 532 to expand. In various embodiments, the anchor is configured tominimize restriction of blood flow when expanded. In variousembodiments, the anchor is configured to allow blood to flow past theanchor. The brace 532 in the expanded configuration can maintain theimpeller 510 in a desired pumping location relative to the heart (e.g.,within the left ventricle 15 and/or disposed across the aortic valve 13)in the presence of forces imparted on the catheter assembly 500 duringpumping.

FIGS. 14A-14B show that the balloon brace 532 can be disposed closer tothe distal end 516 than the proximal end 512. FIG. 15C shows that thelocation of the balloon brace 532 can enable the brace to be expanded inthe vasculature close to the heart when the distal end 516 is disposedin the heart, e.g., in the left ventricle 15. In one embodiment, theballoon brace 532 is configured to be disposed adjacent to or in theaortic arch as shown in FIG. 15C. The balloon brace 532 can be disposedon the elongate body 504 such that when the elongate body 504 isinserted through a peripheral vascular location (e.g., a femoral artery)and advanced to the left ventricle the balloon brace 532 is disposed inthe ascending aorta. Locations in the ascending aorta where the balloonbrace 532 can be disposed include adjacent to, e.g., just upstream of,the brachiocephalic artery. In certain embodiments, the balloon brace532 is disposed on the elongate body 504 such that when expanded theballoon brace 532 is disposed closer to the brachiocephalic artery thanto the coronary arteries. In certain embodiments, the balloon brace 532is disposed on the elongate body 504 such that when expanded the balloonbrace 532 is disposed downstream of the coronary arteries by at leastabout 2 cm. In certain embodiments, the balloon brace 532 is disposed onthe elongate body 504 such that when expanded the balloon brace 532 isdisposed downstream of the coronary arteries by at least about 4 cm.

In other embodiments, the catheter assembly 500 is configured such thatthe balloon brace 532 is positioned on the elongate body 504 such thatwhen the elongate body is inserted through a peripheral vascularlocation (e.g., a femoral artery) and advanced to the left ventricle,the balloon brace 532 is disposed in the descending aorta. For example,the balloon brace 532 can be disposed on the elongate body 504 such thatwhen expanded the balloon brace 532 is disposed downstream of thesubclavian artery by an amount likely to avoid blocking or jailing thesubclavian artery. For example, the brace 532 can be expanded at leastabout 20 mm from the subclavian artery ostium. In other techniques, thebrace 532 can be expanded at a location no closer than 40 mm from thesubclavian artery. In other techniques, the brace 532 can be expanded ata location between the subclavian artery and any of the abdominopelvicbranches. For example, a target zone can be defined as a zone includingthe longitudinal mid-point of the portion of the aorta extending betweenthe subclavian and celiac arteries, the target zone having a length ofno more than about one-half the distance between the subclavian andceliac arteries. A target zone can be defined as a zone including thelongitudinal mid-point of the portion of the aorta extending between thesubclavian and celiac arteries, the target zone having a length of nomore than about one-quarter the distance between the subclavian andceliac arteries. A target zone can be defined as a zone including thelongitudinal mid-point of the portion of the aorta extending between thesubclavian and celiac arteries, the target zone having a length of nomore than about 15% of the distance between the subclavian and celiacarteries. A target zone can be defined as a zone including thelongitudinal mid-point of the portion of the aorta extending between thesubclavian and celiac arteries, the target zone having a length of nomore than about 10% of the distance between the subclavian and celiacarteries.

The balloon brace 532 can be disposed on the elongate body 504 such thatwhen expanded the balloon brace 532 is disposed downstream of thesubclavian artery by at least about 20 mm. The balloon brace 532 can bedisposed on the elongate body 504 such that when expanded the balloonbrace 532 is disposed downstream of the subclavian artery by at leastabout 40 mm.

The balloon brace 532 is configured to reduce obstructions of the flowor only minimally obstruct flow in the vasculature where the balloonbrace is positioned. The balloon brace 532 can be configured with one ormore flow-through channels 540 disposed therein. In various embodiments,the flow-through channels or similar features are configured to allowsubstantially all of the blood flow through the anchor. The flow-throughchannels 540 can be bounded by the balloon brace 532 in part and by theelongate body 504 in part. In other embodiments, the flow-throughchannels 540 can be bounded in part by the vasculature and in part bythe balloon brace 532 when the catheter assembly 500 is disposed in thevasculature and the balloon brace 532 is expanded. For example, in otherembodiments, the balloon brace 532 can have an outer perimeter with atleast one concave portion such that a flow-through channel can bedefined between the concave portion and the vessel wall. This embodimentis useful in allowing more flexibility in the placement of the balloonbrace 532. For example, when the balloon brace 532 is configured toallow flow between the brace and the wall, the balloon brace can beplaced at the same longitudinal position as a branch vessel. Forexample, in certain embodiments the balloon brace 532 can be disposed onthe elongate body 504 such that when expanded the balloon brace 532 isdisposed in the aortic arch, e.g., between the subclavian andbrachiocephalic arteries without posing a risk to the flow in the branchvessels in that location. Although described in terms of flow-throughchannels, one will appreciate from the description herein that otherfeatures may be employed to allow blood to pass by or through the anchorand minimize disruption of the flow.

The portion of the cross-section of the blood vessel obstructed by theanchor (e.g. balloon brace 532) is less than 50 percent in someembodiments. In various embodiments, the anchor is configured toobstruct less than 25 percent of the cross-section of the vessel. Invarious embodiments, the anchor is configured to obstruct less than 15percent of the cross-section of the vessel. In other embodiments, theportion of the cross-section of the blood vessel obstructed by theballoon brace 532 is less than 40 percent. In other embodiments, theportion of the cross-section of the blood vessel obstructed by theballoon brace 532 is preferably between about 10 percent and about 30percent. In other embodiments, the portion of the cross-section of theblood vessel obstructed by the balloon race 532 is preferably betweenabout 5 percent and about 15 percent.

FIG. 15C shows that the balloon brace 532 can be configured as a torus552 in at least the expanded state. The torus 552 has an outer peripherythat is adapted to contact an inner wall of a blood vessel, such as aportion of the aorta. The torus 552 has an inner periphery that in oneembodiment surrounds a portion of the flow-through channel(s) 540. Thetorus 552 can have any cross-section that is symmetrical about an axisof revolution. In such embodiments, the elongate body 504 can bedisposed between the inner periphery of the torus 552 and the axis ofrevolution of the torus 552. This provides an off-set position for theelongate body 504 which in part positions the body 504 closer to thesuperior internal wall of the aorta near the brachiocephalic artery inone embodiment.

Expansion of the torus 552 can be by any suitable structure ormechanism. In one embodiment, an inflation channel 556 is providedbetween the torus 552 and an inflation lumen disposed in the elongatebody 504, e.g., within the catheter body 560. The inflation lumen can bedisposed in a peripheral position, e.g., as one of or in the position ofthe lumens 282 (see FIG. 7). The inflation channel 556 can have a spacethat is fluidly coupled with an interior space of the torus 552 and withthe inflation lumen. The inflation channel 556 can be disposed in one ormore arms extending from the elongate body 504 to the torus 552.

In one embodiment, the balloon brace 532 is configured to deform andconform to the shape of the portion of the aorta in which the balloonbrace is disposed when the catheter assembly 500 deployed in thepatient. The deformation of the balloon brace 532 increases the surfacearea of contact between the balloon brace 532 and the aorta 13 (or othervascular segment in which it is disposed) to increase the secureconnection between the catheter assembly 500 and the aorta 13 (or thevascular segment). The balloon brace 532 can also be asymmetric toenhance engagement with the aorta 13 (or the vascular segment). Forexample the balloon brace 532 can be asymmetric to a plane perpendicularto the longitudinal axis of the elongate body 504. The asymmetry of theballoon brace 532 can provide a wedge-like configuration in the expandedstate of the balloon brace.

FIGS. 14A-14B show that the balloon brace 532 can be disposed on anouter surface of a catheter body 560 similar to the catheter body 120.The brace 532 can be disposed between the catheter body 560 and an innersurface of the sheath assembly 162 in a delivery configuration (e.g., ina collapsed configuration). The brace 532 can be exposed by withdrawingthe sheath assembly 162 until the distal end 170 of the sheath assemblyis proximal of the balloon brace.

In other embodiments, the balloon brace 532 can be disposed on thesheath 162 and thus can be moveable relative to the elongate body 504and the impeller 510. This enables the clinician to change the relativeposition of the balloon brace 532 in the vasculature to selectivelyoptimize the deployment of the pump including the catheter assembly 500.For example, the clinician can elect to place the balloon brace 532upstream or downstream of the aortic arch. The clinician can move theballoon brace 532 to any position within the ascending or descendingaorta. This provides a great degree of flexibility in the selection ofthe vascular location for bracing the working end.

FIG. 14A is a close-up version of a portion of the catheter assembly 500showing visualization devices D1, D2, D3 provided to assist in thepositioning of the balloon brace 532. FIG. 14B shows these same devicesused in connection with mechanically deployable braces 532A. Forexample, a distal visualization device D1 can be disposed at a locationjust distal of the brace 532, 532A to indicate the position of thebrace, e.g., that when expanded the brace 532, 532A will be justproximal to the device D1. The visualization device D1 can be aradiopaque marker, such as a metallic band or zone disposed about thecatheter body 560. The visualization device D1 can be or can include aport for egress of contrast fluid from the catheter body 560. In oneembodiment, a proximal visualization device D2 can be disposed at alocation just proximal of the brace 532, 532A to indicate the positionof the brace, e.g., that when expanded the brace 532, 532A will be justdistal to the device D2. The visualization device D2 can be a radiopaquemarker, such as a metallic band or zone disposed about the catheter body560. The visualization device D2 can be or can include a port for egressof contrast fluid from the catheter body 560. In one embodiments, onlythe proximal device D2 is provided. In one embodiments, only the distaldevice D1 is provided. In one embodiment, both proximal and distalvisualization devices D1 and D2 are provided.

FIG. 14A shows that the proximal device D2 can be disposed at a selectedlocation relative to the location of the distal end 170 of the sheathassembly 162 when the sheath assembly is proximal of the balloon brace532. For example, the brightness of the device D2 can appear the same asthat of the mark D1 indicating that the distal end 170 is proximal ofthe device D2 as shown. The brightness of the device D2 can appear lessthan that of the mark D1 indicating that the distal end 170 is distal ofthe device D2 (or between the devices D1, D2 if both present). In oneembodiment the device D3 is disposed on the elongate body 174 of thesheath assembly 162. Thus the device D3 indicates position of the distalend 170 relative to the balloon brace 532 if the balloon brace isdisposed on the elongate body 504 of the catheter assembly 500. In thisembodiment, the devices D1 and D2 may be omitted.

FIG. 14A illustrates an embodiment in which three or more visualizationdevices are provided on the catheter assembly 500. For example, thedevices D1, D2 can be disposed on the elongate body 504 just distal toand proximal of (respectively) the balloon brace 532 (or mechanicalbrace 532A as in FIG. 14B). A third visualization device D3 can bedisposed on the elongate body 174 of the sheath assembly 162. Thus,real-time information about the proximal-distal location of the balloonbrace relative to the anatomy and of the distal end 170 of the sheathassembly 162 relative to the brace can be ascertained.

In another embodiment, a plurality of brace structures is provided. Forexample, a brace can be provided on both the elongate body 504 and thesheath 162. This enables the clinician to decide which portion of thecatheter assembly 500 will best be braced. This also enables theclinician to decide to brace both the elongate body 504 and the sheath162.

FIG. 14B illustrates an anchor comprising a brace 532A, according toanother embodiment. The brace 532A can be mechanically deployed ratherthan using an inflation medium. The brace 532A comprises a plurality ofpetals or lobes 564 that can extend outwardly from an outer surface ofthe elongate body 504. The lobes 564 can include arcuate portions 568that are configured to be deployed and come to rest on a vascularsurface. For example each lobe 564 can include a convex outer curvature570 that can atraumatically rest on the endothelial lining of the aorta13. For example, the brace 532A can be configured such that apex of thecurvature 570 is disposed away from the central longitudinal axis of thebody 504 by a distance greater than the average radius of the vesselsegment where the brace 532A is to be deployed. However, the gentleslope of the convex outer curvature 570 enables any position along arange on either side of the apex to engage the vessel wall to providesecure engagement. The brace 532A can thereafter anchor a distal portionof the catheter assembly 500 within the patient from a location in thevasculature.

The lobes 564 are configured to be compressed within the sheath assembly162 during delivery and withdrawal of the catheter assembly 500. Forexample, relative distal movement of the distal end 170 of the sheathassembly 162 over an inclined portion 572 of the brace 532A can urge thelobes 564 inwardly (relative to the central longitudinal axis of thebody 504).

In the illustrated embodiment, the brace 532A includes four lobes 564.First and second lobes 564 disposed above and below the elongate body504 are partially shown in cross-section. As second mirror image portionof the first and second lobes 564 would extend out of the page betweendistal portions 574 (shown in cross-section) and the inclined portion572 (also in cross-section). A third lobe 564 is disposed in part behindthe elongate body 504 in the view of FIG. 14B. The third lobe 564 hasfirst and second arms 576 that are symmetrical about a planeintersecting the central longitudinal axis of the elongate body 504 andthe distal portion 574 of the third lobe. The fourth lobe is not shownbut is symmetrical to the third lobe, e.g., coming out of the page inthe image of FIG. 14B. The brace 532A can comprise a shape memorymaterial such as a nickel-titanium alloy (e.g., nitinol), spring steelor other highly elastic material or structure. As such, the brace 532Acan be compressed inside the sheath assembly 162 and expanded asillustrated in FIG. 14B multiple times. While FIG. 14B illustrates oneexample of a mechanically deployable brace, the mechanically deployablebrace 532A can take any other suitable configuration.

B. Sheath Having Expandable Distal End

As described herein, the pump can include a sheath assembly. The sheathassembly can control the collapse and expansion of the impeller and/orthe impeller housing. In some embodiments, the distal end of the sheathassembly can optionally include one or more structures that aid in thedeployment and/or retrieval of the impeller assembly. Such structurescan be configured to be extended over the balloon brace 532 to retrievethe balloon brace after it has been expanded.

In some embodiments, as shown in FIGS. 17A to 17D, the sheath assemblycan include an expandable distal end 170 a, 170 b, 170 c. For example,the distal end can expand when a radial force is applied, and cancontract when the radial force is removed. The distal end may also beable to expand and/or contract repeatedly. When expanded, the distal end170 a, 170 b, 170 c can have a conical and/or funnel-like configuration.When not expanded, the distal end 170 a, 170 b, 170 c can have agenerally cylindrical (e.g., generally constant diameter) configuration,for example as illustrated in FIG. 17A. To assist with expansion and/orcontraction, the distal end 170 a, 170 b, 170 c or portions thereof maybe made from materials having a different flexibility and/or elasticity(e.g., more or less flexible and/or elastic) than the material(s) usedfor all or a portion of the remainder of the sheath assembly. In someembodiments, the sheath assembly 162 can have at least one configurationwhere it is at least partially disposed over the impeller housing,catheter assembly, and/or impeller assembly. Advantageously, the conicaland/or funnel-like configuration can aid the deployment and/orretraction of the impeller assembly and/or impeller housing as describedherein as well as the balloon brace 532 and variations thereof.

As illustrated in FIG. 17A, the distal end 170 a can include one or moreaxial slits 702 (e.g., 2, 3, or 4 slits). Slit 702 can extend proximallyfrom the distal end 170 a at least partially along the length of theelongate body 174. The distal end 170 a can also include a plurality ofelongate members 704 (e.g., 2, 3, or 4 elongate members). Each elongatemember 704 can be joined at one end (e.g., proximal end) to the sheathassembly. Each elongate member 704 can also have a distal end 705 thatis outwardly deflectable away from axis 708. The elongate members 704can be separated from each other by the slits 702. Each elongate member704 can have a width that is defined by the distance between slits 702and a length defined by the length of each adjacent slit 702. In someembodiments, the elongate members 704 and slits 702 can be generallyequally spaced circumferentially about the elongate body 174. In someembodiments, the elongate members 704 can each have a length that isgenerally equal to or greater than the axial length of the outletportion of the impeller housing. For example, in some embodiments, theelongate members 704 can each have a length in the range of from about0.25 in. up to about 2.0 in. In other embodiments, the elongate members704 can each have a length in the range of from about 0.5 in to about0.75 in. The elongate members 704 and/or at least a portion of thesheath assembly 162 (e.g., the portion of the sheath assembly 162 thatconnects to elongate members 704) can be made from a relatively elasticmaterial (e.g., any of the elastomeric polymers described herein).

In use, an outwardly-acting radial force resulting from the radialstiffness of the impeller housing can be applied to the elongate members704 which causes the elongate members 704 to deflect outwards, asillustrated in FIG. 17B. For example, the axial movement of the impellerhousing in the proximal direction into the sheath assembly (or distalmovement of the sheath over the expanded impeller housing) can cause theelongate members 704 to deflect outwards. The outward deflection of theelongate members 704 can result in the conical or funnel-likeconfiguration of the distal end 170 a when sheathed over an expandedsection of the impeller housing. When the elongate members 704 aredeflected outwards, the width of each slit 702 can increase at thedistal end to define a gap 709. In some embodiments, the elongatemembers 704 can be self-collapsing. For example, the elongate members704 can be configured to return to their original configuration when theinternal outward-acting radial forces are released (e.g., where theelongate members 704 are made of a relatively elastic material).

As illustrated in FIG. 17C, the distal end 170 b of the sheath assemblycan include an deformable structure 706 (e.g., a webbing) that at leastpartially covers one or more slits 702. In some embodiments, thedeformable (e.g., stretchable, expandable, flexible, and/or elastic)structure 706 can surround, coat, and/or cover at least a portion of thedistal end 170 b (e.g., the elongate members 704). As illustrated inFIG. 17C, the deformable structure 706 can be an elastomeric coating(e.g., incorporating those elastomeric materials described herein). Inother embodiments, the deformable structure 706 can include a spring,such as a semi-circular spring member having a straight or oscillatorypattern. In use, the deformable structure 706 can be configured toreturn the elongate members 704 to their original, non-conicalconfiguration and/or prevent over-deflection of the elongate members 704beyond their elastic limit.

In some embodiments, the elongate members 704 can be stiffer (in thecircumferential and/or axial direction(s)) than the proximally-adjacentportion of the sheath assembly. Advantageously, the stiffer material canprevent or inhibit the distal-most end of the sheath assembly fromfolding over itself when it encounters resistance (e.g., advancing thesheath over an expanded cannula housing). In one embodiment, one or moreelongate members 704 can be reinforced with a plurality of wires thatextend to the distal-most tip of the elongate member 704. In anotherembodiment, one or more elongate members 704 can be made from a polymerthat is stiffer than the material (e.g., a second polymer) of theproximally-adjacent portion of the sheath assembly.

As illustrated in FIG. 17D, in some embodiments the distal end 170 c ofsheath assembly 162 can include an integral funnel 710 having a distal,conically-shaped portion 711. As described further herein, the integralfunnel 710 can be expandable and/or collapsible. Advantageously, theintegral funnel 710 can assist in deployment and retraction of thehousing while minimally increasing the profile of the pump. The integralfunnel 710 can be connected to a non-expandable portion 712 of thesheath, for example, at a distal-most tip 714. The integral funnel 710can include an outer layer 713 and an inner layer 715 that converge atan interface 717. The integral funnel 710 can be layered over an outersurface 716 and over an inner surface 718 of the non-expandable portion712. Accordingly, as illustrated in FIG. 17D, at least a portion of theinner layer 715 can reside, at least temporarily, within the lumen ofthe sheath assembly 162. The integral funnel 708 can be connected toeither the outer surface 716 or the inner surface 718 of the sheath. Insome embodiments, the funnel 710 can be a distal extension of distal end170 that is folded over the non-expandable portion 712.

The integral funnel 710 can be slideable over the outer surface 716and/or the inner surface 718 of the non-expandable portion 712. Thecontact surfaces between the non-expandable portion 712 and the integralfunnel 710 and/or between the outer layer 713 and the inner layer 715can be lubricated, e.g., using a silicone lubricant, to establish and/ormaintain slideability and/or low friction. The integral funnel 710 canbe made from a thin, flexible material, such as a polyurethane polymer.In some embodiments, the integral funnel 710 can be made from a materialthat is more flexible and/or elastic than the material that is used forall or a portion of the remainder of the sheath assembly. In someembodiments, the material used for the integral funnel 710 can have oneor more membrane-like qualities. In use, the axial movement of thehousing 202 (not shown) can frictionally engage the integral funnel 710,causing the integral funnel 710 to deploy or retract. For example, inembodiments where the outer layer 713 is affixed to the non-expandableportion 712 of the sheath, axial movement of the housing 202 in a distaldirection can cause the inner layer 715 to translate distally (e.g.,slide distally along the inner surface 718 of the sheath), thusdeploying the conical portion 711 (e.g., pulling the conical portion 711out of the sheath). Axial movement of the housing in a proximaldirection can cause the inner layer 715 to translate proximally (e.g.,slide proximally along the inner surface 718 of the sheath), thusretracting the conical portion 711 into the sheath (e.g., pulling theconical portion 711 into the sheath). The thin, flexible material of theconical portion 711 can advantageously allow the conical portion 711 todeform upon retraction of the balloon brace 532 and the housing into thesheath.

In embodiments where the inner layer 715 is affixed to thenon-expandable portion of the sheath, axial movement of the housing 202can cause the outer layer 713 to translate. For example, distal movementof the housing can cause the outer layer 713 to slide distally along theouter surface 716 of the sheath. Proximal movement of the housing cancause the outer layer 713 to slide proximally along the outer surface716 of the sheath.

In some embodiments where the funnel 710 is a distal extension of thenon-expandable portion 712 that is folded over the non-expandableportion 712, the funnel 710 can slide distally as the non-expandableportion 712 is moved proximally. In use, as the non-expandable portion712 is moved proximally, the funnel 710 can slide distally to unfold andsurround the balloon brace 532 and/or the impeller assembly 116.

IV. Methods

Various methods and techniques are discussed above in connection withspecific structures of heart pumps. The following elaborates on someaspects of these techniques and methods. The following discussion is tobe read in light of and freely combined with the foregoing discussion.

A. Retracting and Deploying the Impeller Housing by Way of the ImpellerDeployment Assembly at the Proximal End of the Catheter Body

As discussed above, in various embodiments the heart pump 10 is insertedin a less invasive manner, e.g., using techniques that can be employedin a catheter lab. Various general techniques pertinent to the heartpump 10 are described in U.S. patent application Ser. No. 12/829,359,filed on Jul. 1, 2010, and entitled Blood Pump With Expandable Cannula,which is incorporated by reference herein in its entirety and for allpurposes.

Because the catheter assembly 100 or the catheter assembly 500 is to bedelivered through a small access site, it can be important to ensurethat the impeller housing is reliably deployed and retracted, asdescribed above. A clinician may begin a heart pumping procedure byintroducing the catheter assembly 100 or the catheter assembly 500 intothe patient percutaneously, e.g., by urging the catheter assemblythrough the femoral artery and into a heart chamber. Because theimpeller and impeller housing are advanced through a narrow artery insome embodiments, the impeller and impeller housing can initially beinserted into the patient in a retracted, or collapsed (or low profile),state, as described above. Once the distal end of the catheter assembly100 or the catheter assembly 500 (including their respective impellerhousings) has reached the desired operating location (e.g., a heartchamber), the clinician can deploy the impeller housing into an advancedor expanded configuration. Either before or after deploying the impellerhousing of the catheter assembly 100 or the catheter assembly 500 atechnique can be used to control the position of the impeller housingand/or the magnitude of variation in tip gap between the housing and theimpeller.

1. Superior Aorta Wall Positioning Techniques

As noted above, it is preferred to reduce or minimize variation in tipgap within the impeller assembly 116. One technique is to maintain adistal portion of the catheter assembly 100 (e.g., including theimpeller assembly 116 and a length of the catheter assembly proximallythereof) as straight as possible. Within the anatomy, a substantiallystraight trajectory is defined from a superior portion of or positionwithin the aortic arch adjacent to the brachiocephalic artery, acrossthe aortic valve, and into the left ventricle. The catheter assembly 100can be positioned such that a distal portion thereof follows thisstraight trajectory.

In order to position the distal portion in this manner, the catheterassembly 100 is inserted into the femoral artery and advanced retrogradeover the aortic arch and across the aortic valve. The catheter assembly100 is generally delivered over a guidewire to this position. Oncepositioned, the guidewire can be withdrawn and removed. Thereafter, thecatheter assembly 100 is then positioned superiorly within the aorticarch such that an intermediate portion of the catheter assembly 100extending through the aortic arch is placed in contact with the superiorsurface or aspect of the aortic arch. A portion of the catheter assembly100 distal the aortic arch is maintained straight through the ascendingaorta and the aortic valve. The portion can extend from just upstream ofthe brachiocephalic artery. For example, contact with the superioraspect of the aorta can begin at within about 20 mm of thebrachiocephalic artery and can extend generally in contact with theaortic arch throughout the aortic arch.

In other techniques, the brace 532 can be expanded at a location betweenthe brachiocephalic artery and the aortic valve. For example, a targetzone can be defined as a zone including the longitudinal mid-point ofthe portion of the aorta extending between the brachiocephalic arteryand the aortic valve, the target zone having a length of no more thanabout one-half the distance between the brachiocephalic artery and theaortic valve. A target zone can be defined as a zone including thelongitudinal mid-point of the portion of the aorta extending between thebrachiocephalic artery and the aortic valve, the target zone having alength of no more than about one-quarter the distance between thebrachiocephalic artery and the aortic valve. A target zone can bedefined as a zone including the longitudinal mid-point of the portion ofthe aorta extending between the brachiocephalic artery and the aorticvalve, the target zone having a length of no more than about 15% of thedistance between the brachiocephalic artery and the aortic valve. Atarget zone can be defined as a zone including the longitudinalmid-point of the portion of the aorta extending between thebrachiocephalic artery and the aortic valve, the target zone having alength of no more than about 10% of the distance between thebrachiocephalic artery and the aortic valve.

The superior contact position of the catheter assembly 100 can bemaintained by securing a proximal portion of the catheter assembly 100either inside or outside the vasculature or patient to continue to urgethe catheter body into contact with the superior wall of the aorta atleast in a part of the aortic arch.

2. Positioning Using an Inflatable Balloon Brace

Although the method of creating contact between the catheter body and asuperior aspect of the aorta in at least a part of the aortic arch tomaintaining a generally straight distal portion of the catheter assembly100 is effective, another approach is to provide a positive anchorwithin the vasculature that can be deployed selectively as discussedabove in connection with the catheter assembly 500.

As noted above, the catheter assembly 500 can be positioned in theartery along the same trajectory as shown in FIG. 15A. Once the impellerassembly is disposed in the left ventricle LV, a distal end 170 of asheath is withdrawn to a position proximal of the impeller 510 allowingthe impeller and the cannula within which it is disposed to expand. Theimpeller and cannula are shown schematically in dashed lines in FIGS.15B-15C. The balloon brace 532 can be expanded against the inside wallof the aorta. In one embodiment, the balloon brace 532 is disposedproximally of the impeller 510. The balloon brace 532 can be exposed byfurther withdrawing the distal end 170 to a position proximal of theballoon brace. This step is performed after the step illustrated in FIG.15B. Thereafter, the balloon brace 532 can be expanded. In one techniquethe balloon brace 532 is expanded just upstream of the brachiocephalicartery. The location can be closer to the brachiocephalic artery than tothe coronary arteries. The location can be upstream of but within about2 cm of the brachiocephalic artery. The location can be upstream of butwithin about 4 cm of the brachiocephalic artery. When so expanded theballoon brace 532 holds the catheter assembly 500 anchored at thelocation upstream of the brachiocephalic artery. The trajectory upstreamof the point of anchoring of the balloon brace 532 is substantiallystraight. The straight trajectory minimizes or reduces bending of theimpeller 510 so that tip gap variation between the impeller and theinner wall of the cannula in which it is disposed is reduced orminimized. Also, the anchoring of the portion of the elongate body 504distal of the balloon brace 532 reduces the chance of the intake of thecatheter assembly 500 being expelled from the heart.

When expanded, the balloon brace 532 preserves blood flow by providingthe flow-through passages 540. This ensures that flow is maintained froma distal portion of the brace 532 located at an upstream segment of theaorta extending from the heart to a downstream segment of the aortalocated downstream of a proximal portion of the brace 532.

FIG. 16 shows another method in which the balloon brace 532 is deployedin the descending aorta. In this method, the catheter assembly 500 isadvanced percutaneously to the heart. The sheath 162 is retracted toexpose the impeller and the cannula in which the impeller is disposed topermit the cannula and impeller to expand. The sheath 162 is furtherwithdrawn to expose the balloon brace 532 which in this case is disposedproximally of the impeller by an amount sufficient to align the balloonbrace with a segment of the aorta downstream of the subclavian arterySA. This position is advantageous in that the carotid artery and othercritical arterial branches extending to the brain and arms are safelyavoided. This position of the balloon brace 532 still provides a benefitin that portion of the catheter assembly 500 distal thereof isrelatively short. So the movement of that portion can be more easilycontrolled from this location than from a more proximal location, e.g.,outside the patient. The curved segment through the aortic arch can becontrolled by configuring the balloon brace 532 to hold the catheterbody 504 brace adjacent to and/or in contact with the superior wall ofthe arch. Such contact can be just distal to the balloon brace 532. Thecatheter body 504 can be configured (e.g., reinforced or shaped) tofollow the curvature of the average arch. This configuration tends toplace a distal portion 571 of the curved segment of the catheter body504 disposed through the arch in contact with the superior aspect of thearch just upstream of the brachiocephalic artery to allow a segmentdistal the distal portion 571 to extend substantially straight from thatlocation to and through the aortic valve.

As described above, the balloon brace 532 can be on the sheath 162. Assuch, some methods involve selecting a position to brace the catheterassembly 500. In one method, the impeller and cannula housing theimpeller are expanded by withdrawing the sheath 162 to a position wherethe distal end 170 is proximal to these components. The clinician thendetermines which position of the aorta is most suitable for placement ofthe balloon brace 532. For example, if a straight segment from thelocation just upstream of the brachiocephalic artery to the aortic valveis provided, and there are no issues with critical branches orocclusions in that vascular region, the sheath 162 can be positioned toleave a distal segment thereof including the balloon brace 532 withinthe ascending aorta and the balloon brace is expanded in the positionshown in FIG. 15C. In other variations if the clinician determines thatthe ascending aorta is not a good location for the balloon brace 532,the sheath 162 can be withdrawn to a position in which a distal segmentthereof is in adjacent to the descending aorta. For example, a distalsegment of the sheath 162 including the balloon brace 532 can bepositioned just downstream from the subclavian artery SA, e.g., in aposition corresponding to that of FIG. 16.

In another apparatus and method, each of the catheter body 560 and thesheath 162 includes a balloon brace 532. Where a plurality of braces areprovided the catheter assembly 500 can be more securely braced, e.g.,braced upstream of the brachiocephalic artery and downstream of thesubclavian artery. Alternatively, the clinician can be given the optionof choosing between these two positions and bracing from these twostructures. In certain embodiments, the balloon brace or braces 532 canbe inflated and deflated at select times and/or sequentially. In variousembodiments, two or more braces or anchors are provided. In oneembodiment, a brace is provided at an upstream end of the impeller andanother brace is provided downstream of the impeller. This arrangementprovides further support across the operative zone of the impeller. Inone embodiment, two braces are provided adjacent the impeller, with onebeing upstream and another downstream. The braces can be attached to orintegrated with the cannula housing 518. The braces can be positionedjust proximal to and distal of the ends of the cannula housing. In thismanner the cannula and impeller can be effectively braced duringoperation to reduce the risk of dislocation and undesirable vibrations.

Using balloons and other inflatable structures for the balloon brace 532is advantageous in that the brace 532 can be easily deployed andun-deployed. This allows the clinician to easily place the balloon brace532 and then deflate and reposition the brace. Mechanical brace membersmay be more difficult to retract and reposition.

Once the impeller and the balloon brace 532 are deployed, the cliniciancan conduct the procedure, e.g., by running the heart pump within aheart chamber. Once the procedure is finished, the clinician can removethe catheter assembly from the patient by disengaging the balloon brace532 from the aorta (e.g., by deflating it, retracting the mechanicalbrace members, or capturing the brace) and by retracting the impeller.

B. Controlling the Collapse and Deployment of the Impeller Housing withthe Sheath Assembly

As mentioned above in Section IV(A), it can be advantageous in certainembodiments to enable a clinician to deploy and retract the impellerassembly prior to and after a heart procedure. One method of collapsingthe impeller housing can be performed by advancing the sheath assembly162 distally over the balloon brace 532 and the impeller housing tocollapse the impeller assembly, e.g., for removal of the catheterassembly from the patient after a heart procedure. As mentioned above,elongate body 174 of the catheter assembly 162 can be slidably disposedover the catheter body 120. The clinician can distally advance theelongate body 174 over the impeller housing, or alternatively proximallyretract the catheter body 120 such that the impeller housing collapsesinto the elongate body 174 of the sheath assembly 162.

As FIGS. 17A-D illustrate, the sheath assembly can have expandabledistal ends 170 a, 170 b, 170 c, that expand when a radial force isapplied. Thus, when the clinician advances the elongate body 174 of thesheath over the balloon brace 532 and the impeller housing, the balloonrace and the impeller housing can contact the distal end 170 and caninduce a radial force that causes the distal ends 170 a, 170 b, 170 c,to expand in order to aid in retraction of the impeller assembly.Similarly, when the clinician slides the elongate body 174 in a proximaldirection, the impeller assembly can deploy through the distal end 170of the catheter assembly 162, because the distal ends 170 a, 170 b, 170c, can contract when a radial force is removed (or not applied). Thus,the clinician can reliably deploy and retract the impeller assembly bysliding the elongate body 174 of the sheath relative to the catheterbody 120. In other embodiments, the sheath assembly need not haveexpandable distal ends as described above. The clinician can thereforesimply deploy the impeller assembly 116 by providing relative motionbetween the elongate body 174 of the sheath and the balloon brace andimpeller assembly, e.g., by retracting the elongate body 174 from theimpeller assembly, and can collapse the impeller assembly by providingrelative motion between the elongate body 174 of the sheath and theimpeller assembly 116, e.g., by advancing the elongate body over theimpeller assembly. The distal end of the elongate body 174 can thereforeeffectuate collapse of the balloon brace 532 and the impeller assembly116 without using the expandable distal ends described above. Inembodiments where the impeller assembly is self-expanding, theretraction of the elongate body 174 from the impeller assembly 116 orextension of the impeller assembly 116 out of the elongate body 174 canrelease the impeller assembly to self-expand.

Although the inventions herein have been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent inventions. It is therefore to be understood that numerousmodifications can be made to the illustrative embodiments and that otherarrangements can be devised without departing from the spirit and scopeof the present inventions as defined by the appended claims. Thus, it isintended that the present application cover the modifications andvariations of these embodiments and their equivalents.

What is claimed is:
 1. A catheter pump assembly, comprising: an elongatebody assembly having a proximal end, a distal end and at least one lumenextending therebetween; a shaft disposed at least partially within theelongate body and journaled for rotation; an impeller coupled with adistal portion of the shaft, the impeller configured to be rotated toinduce flow of blood when the impeller is placed in fluid communicationwith a source of blood; and an anchor disposed along an outer surface ofthe catheter pump assembly at an intermediate location and configured tobe deployed therefrom to engage a vascular segment to hold in place aportion of the catheter pump assembly disposed in the patient.
 2. Thecatheter pump assembly of claim 1, wherein the anchor comprises aninflatable balloon brace disposed on an outer surface of the catheterpump assembly, the inflatable balloon brace being spaced proximally fromthe impeller and having a low profile configuration for delivery throughthe vasculature and an expanded configuration for disposing the impellerwithin the source of blood.
 3. The catheter pump assembly of claim 2,wherein the inflatable balloon brace comprises the at least oneflow-through channel disposed therein.
 4. The catheter pump assembly ofclaim 3, wherein the at least one channel is bounded by the inflatableballoon brace or by the elongate body.
 5. The catheter pump assembly ofclaim 2, wherein the elongate body assembly comprises a catheter bodyand a sheath disposed over the catheter body, the inflatable balloonbrace being disposed on the catheter body.
 6. The catheter pump assemblyof claim 5, wherein the sheath comprises a cylindrical distal portionsurrounding the catheter body, the sheath comprising a first position inwhich the cylindrical distal portion is disposed over the inflatableballoon brace and a second position which the inflatable balloon braceis exposed.
 7. The catheter pump assembly of claim 1, wherein theelongate body assembly has a length sufficient to extend from aperipheral vascular location to a ventricle of the heart.
 8. Thecatheter pump assembly of claim 2, wherein the inflatable brace ispositioned on the elongate body assembly such that when the elongatebody assembly extends between the left ventricle and a peripheralarterial location, the inflatable brace is disposed in the descendingaorta.
 9. The catheter pump assembly of claim 2, wherein the inflatablebrace is configured to bias a portion of the elongate body assemblyagainst a superior aspect of the aortic arch when the elongate bodyassembly extends between the left ventricle and a peripheral vascularlocation.
 10. The catheter pump assembly of claim 2, wherein theinflatable brace comprises a torus portion, wherein the elongate bodyassembly is disposed between the torus and the axis of revolution of thetorus portion.
 11. The catheter pump assembly of claim 10, wherein thetorus portion is disposed about a portion of the elongate body assemblyand further comprises an inflation channel extending between aninflation lumen in the elongate body assembly and an interior space ofthe torus.
 12. The catheter pump assembly of claim 11, furthercomprising one or more blood flow channels defined at least in part by asurface of the torus.
 13. The catheter pump assembly of claim 1, whereinthe anchor comprises a plurality of lobes having a compressedconfiguration and an expanded configuration, the lobes extendingoutwardly from the elongate body assembly in the expanded configurationsuch that distal ends of the lobes contact the vascular segment duringoperation of the catheter pump assembly.
 14. A method of positioning acatheter pump, comprising: inserting a catheter pump into a peripheralvascular location, the catheter pump having an elongate body, a flowgenerating device disposed at a distal portion of the elongate body, andan anchor disposed proximally of the flow generating device; advancingthe distal portion of the elongate body to a source of blood; expandingthe brace from a side surface of the elongate body into contact with atarget location within the patient; and operating the flow generatingdevice within the source of blood to induce a blood flow.
 15. The methodof claim 14, wherein the brace comprises an inflation chamber in fluidcommunication with an inflation lumen disposed in the elongate body andwherein expanding the brace comprises flowing an inflation medium intothe inflation chamber.
 16. The method of claim 14, wherein advancingcomprises positioning the flow generating device in fluid communicationwith a left ventricle.
 17. The method of claim 16, wherein advancingcomprises positioning the flow generating device at least partiallywithin the left ventricle.
 18. The method of claim 14, wherein thetarget location includes the descending aorta between the leftsubclavian artery and the peripheral vascular location.
 19. The methodof claim 14, wherein the target location includes the ascending aortabetween the heart and the brachiocephalic artery.
 20. The method ofclaim 14, wherein the target location includes the ascending aortabetween the coronary arteries and brachiocephalic artery.
 21. The methodof claim 14, wherein the brace is configured to position the distalportion asymmetrically in the vasculature when inflated, and furthercomprising orienting the elongate body such that the distal portion ofthe elongate body extends between a central region of and an outer wallof the ascending aorta.